We call kidney failure the condition in which the kidneys lose the ability to carry out their basic functions. Kidney failure can be acute, when there is a sudden and rapid loss of kidney function, or chronic, when this loss is slow, progressive and irreversible.

Therefore, chronic kidney failure, also called chronic kidney disease (CKD), is a disease characterized by the slow and continuous loss of kidney function, a fact that causes, among other changes, the progressive accumulation of toxins and metabolic waste in the blood. It is currently a worldwide public health problem, due to its increasingly high incidence in the population.

The kidneys are complex organs, responsible for multiple functions in our body. Among the main ones, we can mention:

• Elimination of toxins.
• Elimination of useless or excess substances in the bloodstream.
• Control of levels of electrolytes (mineral salts) in the blood.
• Control of body water level.
• Blood pH control.
• Production of hormones that control blood pressure.
• Vitamin D production.
• Production of hormones that stimulate the production of red blood cells by the bone marrow.

According to the best nephrologist in Delhi, patient with chronic kidney disease has deficiencies in each of these functions, which leads to serious health problems in the advanced stages of the disease.

Symptoms

As the onset of chronic renal failure usually occurs slowly, our body has time to adapt to this kidney malfunction, meaning that we do not have signs or symptoms until the very late stages of the disease. The main characteristic of chronic kidney disease is that it is a silent disease.

Many people think they can identify a diseased kidney by pain or a decrease in urine volume. Nothing more false. The kidney has little innervation for pain, so it only hurts when it is inflamed or dilated. As in most cases of chronic renal failure neither one nor the other occurs, the patient may very well find out that he needs dialysis without ever having felt a single kidney pain in his life.

Urine volume is also not a good indicator of kidney health. Unlike acute renal failure (ARF), in which reduced urine production is an almost always present factor, in chronic renal failure, as the loss of function is slow, the kidney adapts well, and the ability to eliminate water remains stable until very advanced stages of the disease. In fact, most patients who need to go on dialysis still urinate at least 1 liter a day.

Therefore, in most cases, until very advanced stages of the disease, chronic renal failure does not cause any symptoms or signs, says the best nephrologist in Delhi.

Patients with CRF in advanced stages may present with anemia and worsening blood pressure values ​​and lower limb edema. When the kidney enters the terminal phase, the symptoms that arise are fatigue, nausea and vomiting, loss of appetite, weight loss, shortness of breath, strong breath (with the smell of urine) and generalized edema.

Diagnosis

As there are no symptoms until advanced stages of the disease, chronic renal failure is usually detected through blood tests, through the dosage of urea and creatinine.

Creatinine is the best marker of kidney function. When the kidneys start to lose function, your blood values ​​rise. However, an elevated creatinine value can occur in acute contexts and alone is not enough to define the diagnosis of chronic kidney disease.

For confirmation of CKD, there must be alterations in renal function or structure, maintained for at least three months. Among these changes we can highlight:

• Presence of protein loss in the urine (proteinuria or albuminuria).
• Changes in the simple urine test, such as hematuria.
• Changes in the structure of the kidneys detected in imaging tests or anomalies in renal biopsy.
• Changes in blood electrolytes related to renal tubular disease.
• Presence of reduced glomerular filtration rate below 60ml/min.
• Presence of kidney transplant.

Blood urea and creatinine research give us information about kidney function, while urine tests, imaging and kidney biopsy provide important data about structural changes in the kidney tissue, which when present for a longer period than three months, are also sufficient to classify the patient as chronic renal failure. 

Urinalysis may indicate kidney disease by revealing protein leakage, bleeding, or inflammation of the urinary tract.

Laboratory analyzes also make it possible to detect complications of chronic kidney disease early, such as initial degrees of anemia, changes in electrolytes (mainly calcium, phosphorus and potassium), changes in the PTH hormone (which controls bone health), blood pH values, etc.

Ultrasonography of the kidneys is also an important exam, as it shows the renal morphology, which can indicate whether the kidneys already have signs of atrophy or anomalies such as polycystic kidney disease. However, it is important to point out that a renal ultrasonography without alterations is in no way sufficient to rule out the hypothesis of CKD.

Finally, we have the renal biopsy that can confirm the involvement of the renal tissue even when the urea and creatinine values ​​are still at normal levels.

Risk factors

Several diseases can attack the kidneys and lead to permanent loss of their function. In general, chronic kidney disease appears when the kidney suffers continuous and prolonged aggression, as in the cases of patients with diabetes or poorly controlled arterial hypertension.

The diseases that most often lead to chronic kidney failure are:

• Arterial hypertension.
• Diabetes mellitus.
• Kidney polycystic disease.
• Glomerulonefrites.
• Recurrent urinary tract infections.
• Recurrent kidney stones.
• Multiple myeloma.
• Lupus and other autoimmune diseases.
• Abusive use of anti-inflammatory drugs.
• Amyloidosis.

If you have any of the above conditions, it is imperative that you regularly monitor your creatinine. At least once a year, creatinine and urea should be measured and a simple urine test should be performed, suggest kidney specialist in Delhi.

When should a patient with CKD be followed up by a nephrologist?

Early referral to a nephrologist in Delhi can change the natural history of the disease. When comparing the evolution of patients referred in stage 3 with those referred only in the final stages of stage 4 or in stage 5, it is noted that:

•  A reduction in the rate of loss of kidney function (3.4 ml/min per year versus 12 ml/min per year), i.e. patients not monitored by a nephrologist in Delhi lose kidney function up to 4 times faster.
• Better control of hypertension and, consequently, less damage to other organs.
• Lower incidence of bone lesions.
• Lower incidence of malnutrition and weight loss.
• Lower mortality rate.

Treatment

There is no cure for chronic kidney disease as it is a reflection of irreversible damage to parts of the kidneys. There is also no medicine that makes the kidneys work well again.

Generally, the goal of CKD treatment is to prevent disease progression or, at worst, to slow the rate of loss of kidney function.

Blood pressure control is essential. Values ​​persistently above 140/90 mmHg are aggressive for the kidney, accelerating the loss of renal function. In patients with diabetes, glucose control is also very important. In patients with proteinuria (loss of protein in the urine), controlling it with medication helps preserve kidney function, says kidney specialist in Delhi.

Patients with CKD should avoid nephrotoxic drugs, such as anti-inflammatories and some antibiotics, especially those from the aminoglycoside class.

Even though there is no cure or specific treatment to improve kidney function, follow-up with a nephrologist in Delhi is important to avoid complications of chronic kidney disease. There are remedies to control anemia, changes in electrolytes, bone metabolism, edema, etc. In the final stages of the disease, when the kidney no longer works, the indicated treatment is hemodialysis, peritoneal dialysis or kidney transplant in Delhi.